Pediatric Symptom Checklist

The Pediatric Symptom Checklist (PSC) is a brief screening questionnaire that is used by pediatricians and other health professionals to improve the recognition and treatment of psychosocial problems in children.

Scoring the PSC

Instructions for Scoring

The standard parent-completed PSC form consists of 35-items that are rated as: “Never”, “Sometimes”, or “Often” present and scored 0, 1, and 2, respectively. Item scores are summed so that the total score is calculated by adding together the score for each of the 35 items, with a possible range of scores from 0-70. If one to three items are left blank by parents, they are simply ignored (score = 0). If four or more items are left blank, the questionnaire is considered invalid. The total score is recoded into a dichotomous variable indicating psychosocial impairment or not. For children aged six through eighteen, the cut-off score is28(28 or above = impaired; 27 or below = not impaired). For children ages 3-5, the scores on elementary school related items 5, 6, 17 and 18 are ignored and a total score based on the 31 remaining items is computed. The cut-off score for younger children is24or greater.

A positive score on the PSC suggests the need for further evaluation by a qualified health (M.D., R.N.) or mental health (Ph.D., LICSW, Psy.D.) professional. Both false positives and false negatives occur, and only an experienced clinician should interpret a positive PSC score as anything other than a suggestion that further evaluation may be helpful.

All forms of the PSC are scored in this same way, although different cut-off scores have been recommended for some of the available versions. Pediatricians whose practices serve a distinct culture should begin by collecting data on a number of cases to ascertain the accuracy of a cut-off score of 28 for their population. If more than 25% or less than 5% of a given population screen positive, it may be especially important to consider using a different cut-off score.

For the Spanish and English versions of the pictorial PSC, the cut-off scores are the same as for the standard parent form.

For the PSC-Youth versions in English and Spanish, a cut-off score of30is recommended (Pagano et al., 2000).

For the Japanese version of the PSC-35, a cut-off score of17is recommended (Ishizaki et al., 2000).

For the German form, the optimal cut-off has been found to be24(Herzog & Thun-Hohenstein, 2007).

For the Dutch version, a cut-offof25 is recommended (Reijneveld et al., 2006).

For the Chilean version of the PSC, subscales for both risk and protective factors are calculated. Detailed instructions for this coding can be obtained by contacting the author Dr. Maria Paz Guzman (mariapazguzman@gmail.com).

PSC Subscales

A 17-item version of the PSC (PSC-17) has also been validated and used successfully to detect youth with psychosocial impairment (Borowsky, Mozayeny & Ireland 2003; Duke, Ireland, & Borowsky 2005; Gardner et al. 2007; Gall et al. 2000). For the PSC-17, a total cut-off score of15has been recommended (Gardner et al., 2007). Although its properties are similar to those of the original PSC 35 form, studies (Gardner et al., 1999; Gardner et al., 2007) do suggest a somewhat greater degree of accuracy with the original form, so it is still the instrument of choice unless time pressures mandate the use of the briefest possible screen.

Subscale scores for internalizing, conduct, and attention problems can be calculated from specific items (Borowsky et al., 2003). The clustering of these items and cutoff scores can be found in Appendix 1 below.

How PARENTS Should Interpret the PSC

It may be helpful for parents or others who administer the form to consult with an experienced clinician if their child receives a PSCpositive score. Data from past studies using the PSC indicate that 2 out of 3 children who screen positive on the PSC will be correctly identified as having moderate to serious impairment in psychosocial functioning. The one child "incorrectly" identified usually has at least mild impairment, although a small percentage of children turn out to have very little actually wrong with them (e.g., an adequately functioning child of an overly anxious parent). Data on PSC-negative screens indicate 95% accuracy, which, although statistically adequate, still means that 1 out of 20 children rated as functioning sufficiently may actually be impaired. The inevitability of both false-positive and false-negative screens underscores the importance of experienced clinical judgment in interpreting PSC scores.

The training required may differ according to the ways in which the data are to be used. Professional school (e.g., medicine or nursing) or graduate training in psychology of at least the Master’s degree level would ordinarily be expected. However, no amount of prior training can substitute for professional maturity, a thorough knowledge of clinical research methodology, and supervised training in working with parents and children. There are no special qualifications for scoring.

Psychometrics

Validity: Using a Receiver Operating Characteristic Curve, Jellinek and his colleagues (Jellinek et al., 1988) found that the PSC cut-off score of 28 has a specificity of 0.68 and a sensitivity of 0.95 when compared to clinicians’ ratings of children’s’ psychosocial dysfunction. In other words, 68% of the children identified as PSC positive will also be identified as impaired by an experienced clinician and, conversely, 95% of the children identified as PSC negative will be identified as unimpaired. Similarly high rates of validity have been reported for the PSC-Y and for the translations of the PSC. This information can be found in the articles cited in the reference section below.

Herzog, S. and L. Thun-Hohenstein (2007). "The predictive value of the pediatric symptom checklist in 5 year-old Austrian children." European Journal of Pediatrics.

Ishizaki, Y., Y. Fukai, Y. Kobayashi and K. Ozawa (2000). "Validation and cutoff score of the Japanese version of the Pediatric Symptom Checklist: Screening of school-aged children with psychosocial and psychosomatic disorders (in Japanese)." The Journal of the Japan Pediatric Society 104: 831-840.